Jane Nafula
24 June 2008
Floods of urine flow continuously from the bladder towards her feet.
Wherever she steps, Mary 20, leaves behind marks of her wet feet.
Mary's misery is clearly written on the face.
This is probably because she is not certain of the day when her reproductive complication she succumbed to due to early marriage will be rectified.
"I really feel very bad, I can't sit with people, I have no friends and wherever I go, people run away from me due to the horrible smell that comes out of me because of the condition I have," Mary says with one of her palms glued on cheeks.
"I can't be employed by any one. I had got a job at one of the restaurants in Soroti after I underwent the first three repairs and my condition improved. Unfortunately, when the fistula re-opened, I was sent away after customers complained of my odour," she adds.
Mary is suffering from a condition called obstetric fistula which is also known as Vesco Vaginal Fistula (VVF), a devastating injury sustained by women due to prolonged or obstructed labour.
The prolonged labour presses the unborn child tightly against the pelvis, cutting off blood flow to the vesico vaginal wall which damages the soft tissues of the vagina, bladder and rectum leaving a woman incontinent of urine and feaces.
Doctors say this condition is common in young girls who cannot push the baby because their pelvic bones have not fully grown.
Mary, who is currently living in one of the internally displaced people's camps in Soroti, developed this condition when she spent five days in labour. She lost her baby during that struggle and also sustained a fistula.
Mary got pregnant at the age of 16. She was forcefully married off by her uncle at a tender age, a few days after her parents were brutally murdered by the LRA rebels in 2003.
The moment Mary's husband realised that she had a fistula, he left her and married another woman, saying he could not stand her condition.
Women activists say several women suffering from fistula have been abandoned by their husbands and isolated by family members. When Mary was abandoned by her husband, she went to seek refuge in an IDP camp in Soroti.
Her only sister was married but her brother in-law never wanted to associate with her. As she was still contemplating the next step, The Association for Rehabilitation of Teso Women for Development (Terrewode) identified her during their study on VVF that was commissioned in 2005. Mary was taken to various hospitals where she was surgically repaired three times.
After surgery, doctors advised her to abstain from sex for six months to allow the ruptured uterus and bladder to heal properly. But unfortunately, Mary slept with a man before six months elapsed and the fistula re-opened.
"We were told that she messed up with a bodaboda man who re-opened her wounds," says Terrewode's Programme Officer, Ms Matha Theno.
Mary's life now hangs in balance as she waits for flying doctors from UK who are expected to come and offer such services this July.
Dr Fred Kiria, a surgeon at Soroti Regional Referral Hospital says Mary's bladder, vagina and uterus were severely damaged.
Dr Kiria, however, says they are contemplating to divert the urine into the intestines so that it can flow out through the anus like faeces.
"We want to create a bladder -like structure in the intestines so that the urine can come out together with the stool," he says
Dr Kiria says there are many women in Uganda who are suffering from this condition but the majority are not known, have no access to treatment due to poverty, poor obstetric care, ignorance about the problem, limited materials and manpower needed in repairing the fistula at health facilities.
"Health workers are few, poorly motivated and remunerated, while the health centres are ill equipped. When you put all this in one basket, you get obstetric fistula," Dr Kiria says.
It is because of such challenges that the European Union through its Civil Society Capacity Building Programme allocated Shs99 million to Terrewode to build the capacity of the local community to identify women with such complications and also promote awareness on the prevention of fistula in Teso sub-region. The campaign has been going on for over one year.
According to Ms Theno, Terrewode has used part of the funds to train 16 women as homebased maternal care takers who are currently identifying fistula patients.
They also sensitise communities on what they should do to avoid obstetric fistula. Ms Theno says EU assistance has seen more women with fistula identified and referred to various hospitals for surgical repairs.
Soroti Regional Referral Hospital for instance has successfully repaired over 200 women. About 70 women are on the waiting list but the hospital administration says it lacks materials needed in the repair.
Surgeons at Soroti hospital say this service is donor dependant and that without their support, very little can be done by the hospital.
VVF repair costs about Shs350,000 per patient yet majority of women cannot afford it. Women's socio-economic vulnerability denies them access to timely and appropriate health care.
Dr Joseph Epodoi, a surgeon at Soroti Hospital, says fistula patients are undergoing social and psychological pain and that supporting preventive measures is the e best solution to the problem.
Joyce, who lived with the fistula for 20 years but was successfully repaired and integrated into the community in 2005, admits that this condition had isolated her from people including her own relatives.
"People here used to call me 'ilwato' (someone who urinates all the times) and distanced themselves from me but when I got rid of this complication, my relatives come to see me and even my neighbour come here for a chat which was not the case before," Joyce says with a smile.
Joyce is now a single mother of seven children. The children belong to four other men that she got after her first husband abandoned her because of the fistula. The four men also abandoned her because of her condition.
But Augustine, a resident of Amusha village, Soroti District is unique. He managed to stick to his wife despite of her condition.
Augustine says he stood by his wife during the trying moment because the Bible recognises the first wives.
His wife had a fistula but she was successfully repaired. In developing countries like Uganda where access to obstetric care is limited, large populations of women still experience fistula.
According to statistics from the Ministry of Health, as many as 130,000 fistula cases occur annually worldwide and up to 3.5 million women are living with the condition.
An estimated 2.6 per cent of women of reproductive age (about 142,000 women) are suffering from this condition in Uganda.
Health experts say taking services close to the people, equipping health facilities, recruiting more health workers and controlling early pregnancies could help Uganda tackle the problem of VVF.
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